Derek Francis Blumenstock

Primary specialty

OptometristTaxonomy code 152W00000X

License

1499 Issued in NE

Practice address

1501 Pine Lake Rd Ste 1
Lincoln, NE 68512-3692

Phone

(402) 421-7773

NPI assigned

Apr 2, 2019

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NE

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

University of Houston - College of Optometry, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bradley J Blumenstock OD PCGroup PAC ID 3678836947, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bradley J Blumenstock OD, PC

  • Health Service Clinic/Center
  • Lincoln, NE
  • NPI 1962906537
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1554163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559606400000",
    "number": "1316409915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6716 S 34TH ST",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685165436",
            "telephone_number": "832-404-0099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 PINE LAKE RD STE 1",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685123692",
            "telephone_number": "402-421-7773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLUMENSTOCK",
        "first_name": "DEREK",
        "middle_name": "FRANCIS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-04-02",
        "last_updated": "2019-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NE",
            "license": "1499",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE ID #",
            "identifier": "1499",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brittney Blum
• Haley Blum, PA-C
• Kyla Jo Blum, MS CCC SLP
• Steven B. Blum, PH.D.
• Bradley J Blumenstock, O.D.
• Angela Blunt
• Kimberly Blunt
• Carrie Bobenhausen, LIMHP
• James A Bobenhouse, M.D.
• Alexis Bock

• Optometrist in Lincoln, NE
• Providers in Lincoln, NE by specialty
• Optometrist in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.